Incidence and management of cervical spine injuries in fatal road traffic accidents

Cervical spine injuries are common in road trauma and resultant damage can be noted through imaging or replicated in biomechanical studies, all of which have limitations. This study provides a unique and important opportunity to correlate prehospital cervical spine treatment with detailed post-mortem cervical spine dissection. Twenty-five of 159 victims of fatal road trauma occurring in a five-month period were treated by ambulance and hospital staff. Cervical injury was sustained by 15 of the victims; injury involved all structures in the cervical spine. The greatest incidence of injury was to the upper cervical motion segments with intramuscular haemorrhage (especially at C1-2) the most frequently seen. Treatment was divided into pre-hospital and hospital care. The primary mode of pre-hospital treatment for cervical trauma was the Vertebrace extrication collar, a specialised cervical collar. The Vertebrace was used in 88% of victims while supplementary supports were employed in 79% of cases. Only 56% of patients underwent cervical x-rays during hospital treatment and a number of these films unsatisfactorily visualised the spine. No correlation between age, gender, blood alcohol, road user or crash characteristics and injury was ascertained, but this may have been due to the sample size and indicates the need for further study in this area.